Uci Health-Fountain Valley — 经济援助与慈善医疗

您是否符合免费医疗的条件？

Uci Health-Fountain Valley 为收入在联邦贫困线 400% 或以下的患者提供免费（慈善）医疗。如果您的家庭年收入在对应家庭人数的金额或以下，您很可能符合 100% 免费医疗的条件：

申请时您需要准备的材料

• Most recent filed Federal tax return or recent paycheck stubs (minimum of six months) to verify family income at or below 400% FPL
• Proof of payment of medical costs (for High Medical Cost patients, receipts if claiming services at other providers in prior 12 months)
• Signed Financial Assistance Screening Form certifying accuracy of information
• Documentation of income and all health benefits coverage

如何申请

拨打电话时，您可以说：“我想为一笔医院账单申请经济援助（慈善医疗）。您能把申请表发给我，并告诉我需要哪些文件吗？”

基于这家医院的政策，生效日期为 07/24/2025。